肠易激综合征患者50例的小肠细菌过度生长和低度炎症反应  

Small intestinal bacterial overgrowth and low-grade systemic inflammation in 50 patients with irritable bowel syndrome

作　　者：陈坚[1] 邱志兵[1] 罗忠光 张会禄[1] 刘杰[1] Chen Jian;Qiu Zhibing;Luo Zhongguang;Zhang Huilu;Liu Jie(Department of Gastroenterology,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院消化内科,上海200040

出　　处：《中华消化杂志》2018年第11期769-773,共5页Chinese Journal of Digestion

摘　　要：目的研究IBS患者小肠细菌过度生长（SIBO）和慢性低度炎症反应的发生率。方法2017年6月至10月，连续收集上海复旦大学附属华山医院消化内科门诊的符合罗马Ⅳ诊断标准的50例IBS患者，应用氢气乳果糖呼气试验（LBT）联合甲烷LBT检测其SIBO的发生率。应用一氧化氮呼气试验检测IBS患者慢性低度炎症反应的发生率。统计学方法采用卡方检验。结果50例IBS患者中，呼出气一氧化氮（FeNO）阳性率为70％（35／50），腹泻型（28例）、便秘型（14例）和混合型（8例）IBS患者呼出气中一氧化氮阳性例数分别为18、11、6例，3组比较差异无统计学意义（χ^2=1．020，P=0．600）。SIBO发生率为60％（30／50），其中单纯氢气LBT阳性者20例（40％），单纯甲烷LBT阳性者7例（14％），二者均阳性者3例（6％）。腹泻型、便秘型和混合型IBS患者呼出气中氢气和甲烷的阳性例数分别为17、3、3例和2、6、2例，3组呼出气中氢气和甲烷阳性率比较差异均有统计学意义（χ^2=6．076、6．392，P均〈O．05）。合并SIBO患者的FeNO阳性率高于不合并SIBO的IBS患者[90％（27／30）比40％（8／20）]，差异有统计学意义（χ^2=14．286，P〈0．01）。结论氢气结合甲烷LBT较传统的单纯氢气LBT对SIBO具有更好的检出率。SIBO与IBS患者的系统性炎症反应的激活存在关联。Objective To investigate the incidence of small intestinal bacterial overgrowth （SIBO） and systemic low-grade inflammation in patients with irritable bowel syndrome （IBS）. Methods From June to October in 2017, 50 cases of IBS patients who met Rome Ⅳ criteria were consecutively collected at Outpatient Department of Gastroenterology of Shanghai Huashan Hospital. The incidence of SIBO was detected by hydrogen lactulose breath test （LBT） and methane LBT. The incidence of systemic low-grade inflammation in IBS patients was determined by fractional exhaled nitric oxide（FeNO） breath test. Chisquare test was used for statistical analysis. Results Among 50 IBS patients, the positive rate of FENO was 70% （ 35 / 50 ）, and t he number of FeNO positive cases in diarrhea-predominant （n=28 ） , constipation predominant （n= 14） and mix-type （n= 8） IBS paitents was 18, 11 and six, respectively, and the difference was not statistically significant among three groups （χ^2=1. 020, P= 0. 600）. The incidence rate of SIBO was 60%（30/50）, with 20 cases （40%） being only positive for hydrogen LBT, seven cases （14%） being methane LBT, and three cases （6%） being both positive. The numbers of hydrogen LBT and methane LBT in diarrhea-predominant, constipation-predominant, and mix-type IBS patents were 17, three, three and two, six, two, respectively. There were statistically significant differences in positive rates of hydrogen LBT and methane LBT among three groups （χ^2 = 6. 076 and 6. 392, both P〈0.05）. The positive rate of FeNO in IBS patients with SIBO was higher than that of IBS patients without SIBO （90%, 27/30 vs. 40%, 8/20）, and the difference was statistically significant （χ^2 = 14. 286, P〈0.01 ）. Conclusions Combination of hydrogen LBT and methane LBT has a higher detection rate of SIBO than traditional single hydrogen LBT. There is a correlation between SIBO and systemic low-grade inflammation in IBS patients.

关 键 词：肠易激综合征 小肠细菌过度生长 乳果糖呼气试验 系统性低度炎症反应 

分 类 号：R574.4[医药卫生—消化系统]